Healthcare Provider Details

I. General information

NPI: 1710936505
Provider Name (Legal Business Name): WILLIAM E. ERVINE JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15976 E HIGH ST
MIDDLEFIELD OH
44062-9474
US

IV. Provider business mailing address

24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 440-632-0408
  • Fax: 440-632-0601
Mailing address:
  • Phone: 440-632-0408
  • Fax: 440-632-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01202202039
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-008594
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: